| NPI | 1679865133 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F347050-01) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 303565-1) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2021-01-15 |