| NPI | 1063790053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.123319) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57-019166) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2018-12-17 |