| NPI | 1215670161 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 12987) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: TX 38874) | |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2022-09-03 |