| NPI | 1003883422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN 19207) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 010043) |
| 122300000X Dentist (Licence: NJ DI02487600) | |
| 122300000X Dentist (Licence: FL DN19207) | |
| 363A00000X Physician Assistant (Licence: NY 010043) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2015-12-03 |