| NPI | 1417410366 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 11736) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63832402) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2020-06-30 |