| NPI | 1265890768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH RES.004739) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61313) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00202733) | |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2024-07-08 |