| NPI | 1033798772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: OH 57.251056) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2022-08-23 |