| NPI | 1982287397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40059) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107774) |
| 122300000X Dentist (Licence: NY 062677) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2024-01-05 |