| NPI | 1770459802 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 1-130919) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-130919) |
| Enumeration Date | 2025-10-15 |
| Last Update Date | 2026-06-19 |