| NPI | 1598258030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 4334) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 11747) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV 4334) | |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2021-04-13 |