| NPI | 1497458699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN28121) |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DN28121) | |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2024-07-02 |