| NPI | 1124608617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12228) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12228) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2021-06-14 |