| NPI | 1962141028 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351049047) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301515142) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2025-08-06 |