| NPI | 1750776803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 154813) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2015017890) |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2022-01-13 |