| NPI | 1710324637 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001362) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15406) |
| 1223G0001X Dentist, General Practice (Licence: MD 15406) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2021-09-19 |