| NPI | 1013643758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: NY 0) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2022-08-03 |