| NPI | 1780004184 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 84321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301106164) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2023-03-20 |