| NPI | 1225659352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1002342-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1002342) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2020-06-30 |