| NPI | 1992133607 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA 314495) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.010748) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2022-09-07 |