| NPI | 1760806582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PR 3189) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR DMD) |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2015-09-04 |