| NPI | 1750056420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: KS 80294) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KS 53-80294-062) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2021-10-11 |