| NPI | 1619663036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 5382456062) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2024037428) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2025-11-10 |