| NPI | 1710875554 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95036308) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95159511) |
| Enumeration Date | 2025-06-27 |
| Last Update Date | 2026-04-28 |