| NPI | 1053060327 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 35770) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV 390200000X) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-01-27 |