| NPI | 1467402024 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 183144) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 2530) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-08-10 |