| NPI | 1700298387 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD5384) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 100086915) |
| 122300000X Dentist (Licence: CO 00202605) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2021-03-26 |