| NPI | 1942199526 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 5022573) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5022573) |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2026-04-24 |