| NPI | 1063655967 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicinist (Licence: OR D11216) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11216) |
| 122300000X Dentist (Licence: NY 055295) | |
| 125Q00000X Oral Medicinist (Licence: NY 055295) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2023-10-23 |