| NPI | 1437611209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 29648) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418829) |
| 124Q00000X Dental Hygienist (Licence: FL DH26534) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRPM2531) | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-12-30 |