| NPI | 1659203529 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 91221) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-86931) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NM 91221) | |
| Enumeration Date | 2026-06-02 |
| Last Update Date | 2026-08-11 |