| NPI | 1629653548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN123341) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN26443) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 122300000X Dentist (Licence: TX 37902) | |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2026-05-05 |