| NPI | 1124784293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MO 2021042810) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: KS 53-80651-092) |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2021-11-12 |