| NPI | 1972217966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23605) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16449-I) |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2024-05-11 |