| NPI | 1033996921 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 000165) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MO 2022019827) |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2025-10-27 |