| NPI | 1568022846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1002022) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1002022) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2019-07-05 |