| NPI | 1356600787 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 054177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101019795) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101019795) | |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2016-05-11 |