| NPI | 1679459259 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209033041) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95036286) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95036286) | |
| Enumeration Date | 2025-08-12 |
| Last Update Date | 2026-01-22 |