| NPI | 1013379346 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN22457) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 10777) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2021-06-03 |