| NPI | 1588303192 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 064218) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000449) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2024-08-28 |