| NPI | 1679916340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-99122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 29005) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 390200000) | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2021-11-19 |