| NPI | 1194464578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17847) |
| 122300000X Dentist (Licence: NH 04765) | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2023-06-30 |