| NPI | 1164658647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301100027) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH acknowledgement ltr) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2021-03-29 |