NPI | 1114453214 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 060587) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022369) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-05-10 |
Last Update Date | 2020-02-04 |