| NPI | 1659892024 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 102851) |
| 1223X2210X Dentist, Orofacial Pain (Licence: PA DS044486) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2024-03-27 |