| NPI | 1710708482 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 112733-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2324536) |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2024-10-24 |