| NPI | 1962977066 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA SP020288) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP019378) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2024-07-19 |