| NPI | 1700885266 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KY 3002674) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1032028) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2017-02-15 |