| NPI | 1285068239 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33959) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62635) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 62635) | |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2018-07-25 |