| NPI | 1699349076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901601470) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2952000756) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2023-04-05 |