| NPI | 1932729506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 37030) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD-00-124) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2021-07-21 |