| NPI | 1689037905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 14021) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30480) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2021-05-10 |