| NPI | 1528509759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 85567-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 61118802) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2025-12-01 |