| NPI | 1558964379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171WV0202X Contractor, Vehicle Modifications |
| Additional Taxonomies | 126800000X Dental Assistant |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |