| NPI | 1184085524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 059312) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 059312-1) |
| Enumeration Date | 2016-03-13 |
| Last Update Date | 2019-03-02 |