| NPI | 1962295386 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN283711) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN283711) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN283711) | |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-05-28 |