| NPI | 1497231914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30025970) |
| 1223G0001X Dentist, General Practice (Licence: TX 38983) | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2022-12-09 |