| NPI | 1134657158 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-77660) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-77660-102) |
| Enumeration Date | 2017-06-03 |
| Last Update Date | 2025-02-13 |