| NPI | 1346779493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11175) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23228) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2020-01-17 |