| NPI | 1518287119 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL unknown) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19127) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL unknown) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2023-05-01 |