| NPI | 1548937675 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 82228) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 82228) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2024-12-03 |