| NPI | 1194471359 |
|---|---|
| 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 17562) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2025-08-24 |