| NPI | 1962799502 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31759) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02474800) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2021-01-11 |