| NPI | 1699302471 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61180680) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61180680) |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: WA 61180680) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-03-27 |