| NPI | 1821814146 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11037463) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9522965) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: FL 11037463) | |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2025-02-19 |