| NPI | 1720225873 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71007997A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 00000000000) |
| 363L00000X Nurse Practitioner (Licence: IL F05170502) | |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2022-07-21 |