| NPI | 1124398045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 055813-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL dn19112) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2015-11-19 |