| NPI | 1720610710 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22184) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 15293-I) |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2021-02-16 |