| NPI | 1548767809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 0258) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 125Q00000X Oral Medicine (Licence: NC 13456) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: NC 13456) | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2026-07-15 |