NPI | 1770331811 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ME176084) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: FL 40588) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2024-05-13 |
Last Update Date | 2025-09-17 |