| NPI | 1760969547 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 313108) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 7363-851) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2022-08-29 |