| NPI | 1972102788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53797490) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-109226-072) |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2021-03-01 |