| NPI | 1871249052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 39380) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2022020481) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2023-07-05 |