| NPI | 1023363298 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 10802) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 10802) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2015-08-18 |