| NPI | 1942786629 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5010699) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5010699) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2025-01-15 |