| NPI | 1770322018 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2952000851) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 27783) |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2024-08-25 |