| NPI | 1710873120 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP033937) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN757908) |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2025-11-03 |