| NPI | 1710247416 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013502) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1023898) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2021-07-09 |