| NPI | 1154942522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 062505) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000387) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2023-07-05 |