| NPI | 1154736254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0401416455) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20626) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2019-09-16 |