| NPI | 1083299267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61475737) |
| Additional Taxonomies | 122300000X Dentist (Licence: WY 1615) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2023-10-11 |