| NPI | 1669303020 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9583266) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95220541) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 540920-01) | |
| Enumeration Date | 2026-05-26 |
| Last Update Date | 2026-06-18 |