| NPI | 1013107572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 256892) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 051467) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2012-07-24 |