| NPI | 1750877114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN23365) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 23365) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2021-06-18 |