| NPI | 1295365757 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2021-02620) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207Q00000X Family Medicine (Licence: NC 2021-02620) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2025-04-03 |