| NPI | 1912260571 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.145379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 41628) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R 9515) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2018-11-22 |