| NPI | 1194469759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61440906) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2951000904) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2023-09-06 |