| NPI | 1295110872 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 059197) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041140) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2018-08-02 |