| NPI | 1891729067 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9267346) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000005536) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2008-04-22 |