| NPI | 1336677293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN015322) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2017-05-23 |