| NPI | 1861715468 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 392-33) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 392-33) |
| 363L00000X Nurse Practitioner (Licence: WI 68680-30) | |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2013-12-27 |