| NPI | 1124434659 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 057262) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 05 057262) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2020-05-03 |