| NPI | 1003235417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16141) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT015694) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2020-03-15 |