| NPI | 1750962262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE6160481) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 110559) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2025-01-08 |