| NPI | 1801204508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 104339) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 059687) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 12163) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2021-02-08 |