| NPI | 1831692425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CT 13249) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: RI DEN03625) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 12212) | |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2022-11-01 |