| NPI | 1508434374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 12319) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2021-07-27 |