| NPI | 1992293054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 061509) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 104261) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2020-12-05 |