| NPI | 1194165233 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-6078) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1514) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2020-01-27 |