| NPI | 1902367022 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 309206) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2022-09-20 |