| NPI | 1528640315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX U3843) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 78101) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2024-06-11 |