| NPI | 1659315315 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71000702A) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: IN 28122181A) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2024-09-06 |