| NPI | 1558754937 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025559) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 30.025559) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2024-02-28 |