| NPI | 1902415706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 82215) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 8257-851) |
| 207Q00000X Family Medicine (Licence: WI 76507-20) | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2026-06-09 |