| NPI | 1760914733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 009139) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 20207QA0401X) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2019-03-14 |