| NPI | 1821753237 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024743) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN623921) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2024-03-21 |