| NPI | 1568042901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2025003017) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.034537) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2026-01-05 |