| NPI | 1558564823 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 51871-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016351) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101016351) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2021-02-03 |