| NPI | 1679451165 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1212558) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 909885) |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-09-18 |