| NPI | 1649828013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38265) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30555) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2022-04-13 |