| NPI | 1841730611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 9835) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 9800) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 021.003026) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2022-01-31 |