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 |