| NPI | 1801021944 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 055263) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD D14440) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 55263-1) | |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2024-08-22 |