| NPI | 1942855689 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 21513) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21512) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2024-08-21 |