| NPI | 1932591633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 058837) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 9175802316) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2019-10-01 |