| NPI | 1649908617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: CA 108187) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 108187) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 12939616-9921) | |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2026-06-23 |