| NPI | 1295354140 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: IA R-12700) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2023-05-29 |