| NPI | 1508224155 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NY 062433-01) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN 22291) |
| 122300000X Dentist (Licence: MA DN1858222) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2025-03-18 |