| NPI | 1942764923 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 5379485031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-89637-031) |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2021-02-24 |