| NPI | 1699737189 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT CT000946) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 000946) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2010-10-04 |