| NPI | 1598692204 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: WI 8996) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2026-05-06 |
| Last Update Date | 2026-07-22 |