| NPI | 1841797297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418709) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 104134) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2024-03-28 |