| NPI | 1952087082 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2024039723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28223072A) |
| 363L00000X Nurse Practitioner (Licence: IN 71014169A) | |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2025-01-29 |