| NPI | 1982026373 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP012804) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP012850) |
| Enumeration Date | 2014-01-20 |
| Last Update Date | 2020-12-03 |