| NPI | 1811204092 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 11199680-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.023522) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 122300000X Dentist (Licence: CA 63979) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2023-02-16 |