| NPI | 1104422492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3015542) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3015542) |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2021-09-24 |