| NPI | 1881254878 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95031611) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-12-14 |