| NPI | 1710713730 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901602574) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: LA 7621) |
| Enumeration Date | 2024-09-09 |
| Last Update Date | 2025-08-27 |