| NPI | 1356721542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415525) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC 1002117) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2020-07-05 |