| NPI | 1215632682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-00191) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL23-0521) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-08-04 |