| NPI | 1023321437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V0172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54600) |
| 208D00000X General Practice (Licence: MI 4301096990) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2024-03-28 |