| NPI | 1235781204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 21455) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21455) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2024-10-06 |