| NPI | 1902099716 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-00205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME100735) |
| 207Q00000X Family Medicine (Licence: HI MD15845) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN9975) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2014-08-08 |