| NPI | 1699436170 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23178) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16060-I) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16060-I) | |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2023-04-25 |