| NPI | 1548960172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN30184) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10956) |
| 1223G0001X Dentist, General Practice (Licence: KY 10956) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2025-08-21 |