| NPI | 1710420898 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95015729) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN210713) |
| 163W00000X Registered Nurse (Licence: WA RN60250763) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10697) | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2022-03-16 |