| NPI | 1679647226 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 302527) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 340379) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2025-01-22 |