| NPI | 1710212816 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-02072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD 34407) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58-003244) | |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2019-06-24 |