| NPI | 1982564605 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: GA LPN086099) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN219095) |
| Enumeration Date | 2025-11-14 |
| Last Update Date | 2025-11-14 |