| NPI | 1447892518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DRPM2576) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 12646) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2023-06-21 |