| NPI | 1063762946 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 5375758051) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-75758) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2025-06-06 |