| NPI | 1972291813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 065384-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 110662) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2026-06-10 |