| NPI | 1104389410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77224) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2023-02594) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2024-06-27 |