| NPI | 1689169575 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209018198) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017032885) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2023-11-27 |