| NPI | 1215199518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A111245) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2021-12-27 |