| NPI | 1043635956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 058527) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058527) |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2017-05-03 |