| NPI | 1801768585 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1191350) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1191350) |
| Enumeration Date | 2025-09-22 |
| Last Update Date | 2025-10-24 |