| NPI | 1093436693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23915) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 00150-PA) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16518) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16518-I) | |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2024-07-23 |