| NPI | 1609660315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 14517) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 110484) |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2025-07-21 |