| NPI | 1649848425 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F353996) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 783755) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2024-08-07 |