| NPI | 1174960181 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 260156) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057275) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-01-02 |