| NPI | 1164880787 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31847) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH RES.3571) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2016-06-07 |