| NPI | 1356835896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 09572) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 09572) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2021-12-14 |