| NPI | 1548529670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13353) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: MA DN1856237) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN D13353) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2016-04-08 |