| NPI | 1740775345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 09578) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09578) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-07-30 |