| NPI | 1972128619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351046665) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046665) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2020-08-06 |