| NPI | 1417390824 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 63560) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 66057-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2021-10-07 |