| NPI | 1649808486 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601997) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10575) |
| 122300000X Dentist (Licence: MN D14629) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2023-12-08 |