| NPI | 1609455039 |
|---|---|
| Former Name | MCKENZIE KYLE TIMMS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D14575) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-04 |
| Last Update Date | 2021-06-04 |