| NPI | 1679129027 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2019030273) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS TMP-158886) |
| 363LF0000X Nurse Practitioner Family (Licence: KS 53-78932-051) | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2020-03-01 |