| NPI | 1891405379 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN F11220416) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 33037) |
| Enumeration Date | 2022-11-25 |
| Last Update Date | 2024-09-26 |