| NPI | 1043886880 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7210) |
| 122300000X Dentist (Licence: NC 12384) | |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2021-08-08 |