| NPI | 1689173585 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 3012056) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71013692A) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3012056) | |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2025-02-02 |