| NPI | 1629620406 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 78872) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 53-78872-062) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-07-30 |