| NPI | 1477297836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 4669) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12883) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2024-04-30 |