| NPI | 1700255304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA11230600) |
| Additional Taxonomies | 101Y00000X Counselor |
| 207Q00000X Family Medicine (Licence: PA MD475295) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2021-11-04 |