| NPI | 1053748228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 17231) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 29790) |
| 1223G0001X Dentist General Practice (Licence: VA 0401416758) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2020-02-22 |