| NPI | 1679063937 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9267) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: MD 17167) | |
| Enumeration Date | 2018-05-12 |
| Last Update Date | 2024-03-11 |