| NPI | 1205105624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75551-21) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75551-121) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2014-10-07 |