| NPI | 1619394558 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R6725) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 130537) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-27 | 
| Last Update Date | 2024-04-30 |