| NPI | 1740807387 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13105) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019032709) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2021-05-27 |