| NPI | 1336643485 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 12587) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2019-07-24 |