| NPI | 1619906534 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 739475) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 45736) |
| 207P00000X Emergency Medicine (Licence: TX 739475) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 739475) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2017-02-15 |