| NPI | 1780138891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016029746) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-77326-082) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2021-07-28 |