| NPI | 1679214092 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 11320) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011942) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2025-07-15 |