| NPI | 1700547270 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024735) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA F09211111) |
| 207Q00000X Family Medicine (Licence: PA SP024735) | |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2025-01-20 |