| NPI | 1578143459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 4671896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 103031-875) |
| 207Q00000X Family Medicine (Licence: IL 036.167759) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2026-08-24 |