| NPI | 1861846255 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 34449) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015483) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2018-08-03 |