| NPI | 1639558794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 83740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-01305) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2019-07-29 |