| NPI | 1053605808 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 056292-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056292) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2020-02-19 |