| NPI | 1356861579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 36730) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223G0001X Dentist General Practice (Licence: IL 019032303) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-02-07 |