| NPI | 1154636462 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX Q6363) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 12672i) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2017-02-22 |