| NPI | 1760969554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73105-20) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 98329) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 7186-851) | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2024-01-08 |