| NPI | 1154522753 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.126803) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57-012886) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2012-04-04 |