| NPI | 1003339953 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 061036) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857701) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2021-02-25 |