| NPI | 1104145465 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 08808) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6503-015) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2013-01-31 |