NPI | 1386164762 |
---|---|
Former Name | KATHY FERNANDEZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16491) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2017-06-26 |
Last Update Date | 2017-08-01 |