| NPI | 1922411636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 83556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301113271) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT207016) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2022-07-21 |