| NPI | 1720511462 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-77364-111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017010119) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2018-03-17 |