| NPI | 1023716073 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 39481) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 39481) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2024-04-23 |