| NPI | 1063083350 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN34685) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY P110383) |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2022-06-10 |