| NPI | 1558828475 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: IA DDS-09886) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30557) |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2021-06-29 |