| NPI | 1154168086 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-83411-121) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2012023983) |
| 163W00000X Registered Nurse (Licence: KS 14-116708-121) | |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2024-12-18 |