| NPI | 1275206864 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SD 76423) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09928) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA DDS-09928) | |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2023-12-02 |