| NPI | 1205333770 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 12850) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600557) |
| 122300000X Dentist (Licence: TX 35702) | |
| 122300000X Dentist (Licence: MA DN1857982) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2020-08-05 |