| NPI | 1275899163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2020-03395) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME120759) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-04-01 |