| NPI | 1467243154 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 433153) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NY 767400) |
| Enumeration Date | 2025-05-13 |
| Last Update Date | 2025-05-13 |