| NPI | 1306464524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859346) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 363679194) |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2022-08-11 |