| NPI | 1164086807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30678) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D14186) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2024-05-08 |