| NPI | 1164917340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: OR DO225010) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101024319) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2025-08-25 |