| NPI | 1831770296 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 062952) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 018.002184) |
| Enumeration Date | 2021-04-17 |
| Last Update Date | 2023-08-08 |