| NPI | 1205539251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11415) |
| 208000000X Pediatrics (Licence: MO 2023021638) | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-07-09 |