| NPI | 1043523582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30996) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 0554931) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 50-055493) | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2016-06-02 |