| NPI | 1104445477 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 17210) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1002224) |
| 122300000X Dentist (Licence: VA 0401417407) | |
| 1223G0001X Dentist, General Practice (Licence: MD 17210) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2021-05-26 |