| NPI | 1346875978 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36824) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD5511) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD-00-121) | |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2022-08-03 |