| NPI | 1952750382 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103530) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D010147) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1857705) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2019-02-05 |