| NPI | 1003376203 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM DO2022-0143) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 125.075065) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2024-06-06 |