| NPI | 1255776225 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 63841) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD0051) |
| Enumeration Date | 2013-05-05 |
| Last Update Date | 2014-10-21 |