| NPI | 1891074753 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 065009-23) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN260716) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2023-06-23 |