| NPI | 1508044801 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-46142-061) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 1999137665) |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2012-01-20 |