| NPI | 1841992989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN R886) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-10095) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2024-10-03 |