| NPI | 1306209648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022117) |
| 1223G0001X Dentist, General Practice (Licence: CA 102007) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2020-05-12 |