| NPI | 1053600296 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 41619) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: pending) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2014-09-24 |