| NPI | 1972662724 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4339) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-01537) |
| 163WM0102X Registered Nurse, Maternal Newborn (Licence: AZ RN086776) | |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2012-04-02 |