NPI | 1619417763 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 10217) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 060054) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-03-07 |
Last Update Date | 2023-08-11 |