| NPI | 1932639143 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024175108) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: VA 0024175108) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-01-31 |