| NPI | 1114684313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80660-051) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021050327) |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2022-10-11 |