| NPI | 1902792146 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11044226) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 40543) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2026-01-07 |