| NPI | 1730718537 |
|---|---|
| Former Name | ANNA AUGUSTINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: WI 1002764-15) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30600) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2022-07-19 |