| NPI | 1568042877 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 062615) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 062615) |
| 1223G0001X Dentist, General Practice (Licence: PR 3418) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2022-08-29 |