| NPI | 1861070955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 41367) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17880) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN200059) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-07-14 |