| NPI | 1679133813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 92795) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019278) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-11-14 |