| NPI | 1699413948 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859425) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN26946) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-12-21 |