| NPI | 1740728708 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11005228) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: FL DO6751) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2022-12-20 |