| NPI | 1174259618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418103) |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-08-22 |