| NPI | 1427445113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001941) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414897) |
| 122300000X Dentist (Licence: MD 16125) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2019-05-21 |