| NPI | 1629579578 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA F01181389) |
| Additional Taxonomies | 208800000X Urology (Licence: GA RN308281) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3012071) | |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2023-04-12 |