| NPI | 1790669299 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95036495) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95036495) |
| Enumeration Date | 2025-08-05 |
| Last Update Date | 2025-09-18 |