| NPI | 1083091664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 312294) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040260) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 062309) | |
| Enumeration Date | 2015-05-02 |
| Last Update Date | 2023-03-17 |