| NPI | 1932466851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61145) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223P0300X Dentist, Periodontics (Licence: MO 2016015261) | |
| 122300000X Dentist (Licence: MN D13101) | |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2016-06-16 |