| NPI | 1023642063 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80374-022) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2016024418) |
| 163W00000X Registered Nurse (Licence: KS 13-136461-022) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2021024639) | |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2025-01-03 |