| NPI | 1972235125 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 15675) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105822) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2024-09-22 |