| NPI | 1619334117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15834) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD LL758) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2022-09-14 |