| NPI | 1083078315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 90144) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 76451) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 646517) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 70750) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2025-04-07 |