| NPI | 1164683546 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 060943-01) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8587) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2022-03-28 |