| NPI | 1104798628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-84092-082) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-84092-082) |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2026-01-16 |