| NPI | 1902347313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 92110) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R4463) |
| 207Q00000X Family Medicine (Licence: KY 53626) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2022-07-15 |