| NPI | 1316316912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058736) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 058736) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2017-11-02 |