| NPI | 1639790033 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-03008) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 261647) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2022-12-04 |