| NPI | 1710872114 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP033077) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: PA RN615935) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-06-11 |