| NPI | 1710682190 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 42123) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 18251) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2025-12-08 |