| NPI | 1649549015 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: AK CHAII) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: AK 04-008 EFD-HA1) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2015-01-06 |