| NPI | 1043726920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 113548) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21320) |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2026-07-13 |