| NPI | 1053995134 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13410) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600940APP21) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2022-05-25 |