| NPI | 1699515361 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP029715) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP029715) |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-12-31 |