| NPI | 1629951447 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 11041232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL APRN11041232) |
| Enumeration Date | 2025-07-29 |
| Last Update Date | 2026-06-12 |