| NPI | 1356579643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 48149) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-8719) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2019-11-04 |