| NPI | 1639413339 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 75764) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2012039131) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2019-04-04 |