| NPI | 1720346695 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301108411) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 61589-20) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2015-07-07 |