| NPI | 1871251926 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 13519115-8900) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 13519115-4405) |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2025-02-01 |