| NPI | 1619428364 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 5377435082) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2016038312) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-27 |