| NPI | 1679274963 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KS 160463) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: KS 51931) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2024-12-26 |