| NPI | 1336819903 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI NO.81931-21) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI PAR-0000088506) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2025-07-07 |