| NPI | 1215324041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2024003677) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60663717) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2025-07-17 |