| NPI | 1063791267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36832) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056115) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2021-03-05 |