| NPI | 1174025621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NC 11229) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2021-08-31 |