| NPI | 1902549843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R3792) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 011951) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2026-09-09 |