| NPI | 1265063929 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79475-071) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 113638) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2020023501) | |
| Enumeration Date | 2020-01-31 |
| Last Update Date | 2024-06-27 |