| NPI | 1902280977 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 31092) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4437) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM ETN357) | |
| Enumeration Date | 2015-07-19 |
| Last Update Date | 2025-01-03 |