| NPI | 1346736097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 13160) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026380) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 12334) | |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2023-02-10 |