| NPI | 1356841753 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 062121) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 062121) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02823200) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2023-10-12 |