| NPI | 1174833370 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101253761) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57-018398) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2019-09-26 |