| NPI | 1104169523 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 057301-1) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 39200000x) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2015-09-21 |