| NPI | 1871153734 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011973) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139432) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP139432) | |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2019-06-13 |