| NPI | 1104388198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN25243) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 061324) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2021-07-21 |