| NPI | 1356086839 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80880-111) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KS 5380880-111) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2023-01-25 |