| NPI | 1790419752 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 79879) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT226394) |
| 207V00000X Obstetrics & Gynecology (Licence: MN 79879) | |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2025-09-08 |