| NPI | 1902498926 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MN L048820-8) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: TX 344307) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2025-02-11 |