| NPI | 1912327438 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ND 15804) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 15804) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 2366) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: ND 15804) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2025-09-24 |