| NPI | 1982621405 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2003024630) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2003024630) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-09-12 |