| NPI | 1902788532 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 39250) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 39250) |
| 363L00000X Nurse Practitioner (Licence: TN 39250) | |
| Enumeration Date | 2025-07-24 |
| Last Update Date | 2025-12-10 |