| NPI | 1679730790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D9829) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE60632860) |
| 1223G0001X Dentist, General Practice (Licence: FL DN18563) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN 1855133) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2020-05-20 |