| NPI | 1780018739 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 23459) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 002417105) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2013-08-27 |