| NPI | 1760508105 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 423710) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F340584) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |