| NPI | 1649958455 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KS 162184) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: KS 53569) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2024-02-06 |