| NPI | 1821462623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 51072) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 51072) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2016-02-01 |