| NPI | 1609407477 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 79580) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: KS 108956) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2024-09-09 |