| NPI | 1811691363 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA DDS10199) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.034487) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2024-05-07 |