| NPI | 1225646417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 53-79531-011) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2016026783) |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-07-14 |