| NPI | 1295867562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 21230) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 11380) |
| 122300000X Dentist (Licence: MA 21230) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2015-08-27 |