| NPI | 1629319694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414729) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR60360697) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2019-08-28 |