| NPI | 1770864217 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75455-122) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2011032981) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2023-12-18 |