| NPI | 1861955809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2021013177) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 104696) |
| 1223G0001X Dentist, General Practice (Licence: MO 2021013177) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2021-06-29 |