| NPI | 1679404859 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: ND R50625) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ND 205432) |
| Enumeration Date | 2026-05-27 |
| Last Update Date | 2026-08-07 |