| NPI | 1245875996 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79593-111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014113) |
| Enumeration Date | 2019-11-16 |
| Last Update Date | 2021-07-14 |