| NPI | 1104480763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 5345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R5098) |
| 207Q00000X Family Medicine (Licence: KY TP961) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2022-09-21 |