| NPI | 1508509019 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD22026) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD-00-158) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2024-04-12 |