| NPI | 1285174102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 35092) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 102545) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2019-08-11 |