| NPI | 1659831618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9963) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: NC 11717) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2021-08-05 |