| NPI | 1063156628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN123253) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN28506) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2023-08-18 |