| NPI | 1760976138 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME168639) |
| 207Q00000X Family Medicine (Licence: MI 4301503007) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-06-06 |