| NPI | 1194176065 |
|---|---|
| Former Name | AIDA FAKHRUTDINOVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059368) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2017-08-17 |