| NPI | 1750248233 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95039827) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95349463) |
| Enumeration Date | 2026-01-07 |
| Last Update Date | 2026-05-30 |