| NPI | 1831763622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 80200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 53-80200-072) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2022-02-02 |