| NPI | 1861597890 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA TP005778L) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA TP005778L) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2012-01-24 |