| NPI | 1962757807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1531) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY 1534) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2022-02-08 |