| NPI | 1528595907 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN23229) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060060) |
| 1223G0001X Dentist, General Practice (Licence: NY 060060) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2022-03-01 |