| NPI | 1366227712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 14125) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX ETN1069) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2025-07-23 |