| NPI | 1538803242 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2022018770) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61887) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2023-12-06 |