| NPI | 1164842407 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16593) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31473) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2022-07-21 |