| NPI | 1518220003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: AL MD.38005) |
| Additional Taxonomies | 2086S0129X (Licence: AL 38005) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100787) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2024-02-01 |