| NPI | 1083240139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600525) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901600525) | |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2026-05-30 |