| NPI | 1649027962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 14838) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30702) |
| Enumeration Date | 2024-05-03 |
| Last Update Date | 2026-06-28 |