| NPI | 1811871890 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 357569) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 752453) |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-08-04 |