| NPI | 1427755693 |
|---|---|
| Other Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.034104) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601611) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2023-03-13 |