| NPI | 1255977153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2019038059) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-79074-062) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2019-11-26 |