| NPI | 1790422061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 064513-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001068-15) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2025-06-03 |