| 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 |