| NPI | 1871127811 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 39445) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 12743) |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2023-05-30 |