| NPI | 1245692847 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: AZ D009689) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D009689) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2021-08-24 |