| NPI | 1558967604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79781-052) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020034605) |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2021-02-04 |