| NPI | 1447612106 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 060379) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041157) |
| 1223G0001X Dentist General Practice (Licence: MD 17419) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-09-12 |