| NPI | 1790063378 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: DE C2-0023991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS016775) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH FD0180442-32) | |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2022-04-01 |