| NPI | 1326626029 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 13044) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 13044) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 00000) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30602) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2023-06-25 |