| NPI | 1548753494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 17040) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 060648) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2021-01-01 |