| NPI | 1912995010 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP1220062) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 332949) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA 227601) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2015-03-05 |