| NPI | 1669106548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DN122781) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122781) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2023-06-30 |