| NPI | 1154065514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13758) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1859415) |
| 1223G0001X Dentist, General Practice (Licence: CT 13636) | |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2024-02-20 |