| NPI | 1043748593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN23035) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 059906) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-29 |
| Last Update Date | 2019-12-02 |