| NPI | 1164653630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 054477-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019567) |
| Enumeration Date | 2009-08-01 |
| Last Update Date | 2009-08-01 |