| NPI | 1376740084 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30388) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6715) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2015-07-24 |