| NPI | 1972916930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21146) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857558) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-07 |
| Last Update Date | 2021-08-31 |