| NPI | 1316411994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 13243588) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 43783841) |
| 122300000X Dentist | |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2022-07-21 |