| NPI | 1043735996 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 37671) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NE 7874) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2023-08-04 |