| NPI | 1710669544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23512) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2024-03-03 |