| NPI | 1063570596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 08374) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 8374) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2018-08-14 |