| NPI | 1043526437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 055506) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038738) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2015-10-21 |