| NPI | 1164171302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101286754) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301514702) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2025-09-19 |