| NPI | 1235868217 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 40282) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859479) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2024-12-03 |