| NPI | 1225719966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: PR 118R) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 118R) |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2024-08-02 |