| NPI | 1821539594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 60741) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6902) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2019-11-13 |