| NPI | 1982956850 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 922) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1655700) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2025-02-19 |