| NPI | 1912646027 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D15045) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30643) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2024-11-06 |