| NPI | 1700565769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 13916) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 13916) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-10-19 |