| NPI | 1174106157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 1371) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 15608i) |
| 261QP2300X Clinic/Center, Primary Care (Licence: FL 1371) | |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2021-12-22 |