| NPI | 1760904742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30518) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031160) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 1002269-15) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2023-08-14 |