| NPI | 1366929168 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30653) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12617) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2023-06-08 |