| NPI | 1093987158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056390) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 056390) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2021-02-11 |