| NPI | 1871918284 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 011366) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 057814) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2023-07-21 |