| NPI | 1164834628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 058135) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2017012302) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-08-05 |