| NPI | 1003440512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26829) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL DN26829) |
| 122300000X Dentist (Licence: FL DN26829) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRPM2123) | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2022-05-19 |