| NPI | 1376808196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD5569) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9476) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2022-04-20 |