| NPI | 1073161147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30651) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10284) |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2023-06-08 |