| NPI | 1972216703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 14071) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS108353) |
| Enumeration Date | 2022-12-26 |
| Last Update Date | 2024-06-10 |