| NPI | 1003639121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.260905) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2023021151) |
| 208D00000X General Practice (Licence: MO 2023021151) | |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2026-05-27 |