| NPI | 1962170712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020041684) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79872-051) |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2021-09-04 |