| NPI | 1003310053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD5351) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7039) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD-00-105) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2024-10-17 |