| NPI | 1558056143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 31214) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 2578) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-01-02 |