| NPI | 1073161147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10127) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10284) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.027082) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA DDS-10127) | |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2025-06-16 |