| NPI | 1295476794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 7983) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D14864) |
| 122300000X Dentist (Licence: TX 38614) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-01-30 |