| NPI | 1770062275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 11155) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA FAC-40207) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30541) | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2024-10-11 |