| NPI | 1023247640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 055413) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 010067) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 055413) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2011-03-18 |