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 |