| NPI | 1053814277 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PR 3305) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2952000752) | |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2024-07-01 |