| NPI | 1770117863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2019046863) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-79310-112) |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2020-02-27 |