| NPI | 1891397113 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020034554)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 5381461)  | 
| Enumeration Date | 2020-11-11 | 
| Last Update Date | 2022-09-12 |