| NPI | 1801156591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NY 056643-1) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 056643-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2022-07-21 |