| NPI | 1689467524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 14155) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 14155) |
| 171000000X Military Health Care Provider (Licence: NC 14155) | |
| Enumeration Date | 2025-05-23 |
| Last Update Date | 2025-08-07 |