NPI | 1295377059 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 061831) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 061831) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-10-14 |
Last Update Date | 2022-01-24 |