| NPI | 1922505874 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS105062) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34964) |
| 122300000X Dentist (Licence: AZ D010939) | |
| 1223G0001X Dentist, General Practice (Licence: TX 34964) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-08 |
| Last Update Date | 2023-01-01 |