| NPI | 1962947333 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KY 3017371) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 240073) |
| 163W00000X Registered Nurse (Licence: NY 721646) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 30989) | |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2022-04-04 |