| NPI | 1558467530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN19963) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053618) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2015-03-06 |