| NPI | 1306536958 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 064085) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 390200000X) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-09-25 |