| NPI | 1043662422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2016-07-08 |