| NPI | 1821655390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 30544T) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2022-06-27 |