| NPI | 1619853769 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95036365) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95036365) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95036365) | |
| Enumeration Date | 2025-08-13 |
| Last Update Date | 2025-08-13 |