| NPI | 1316552409 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 061463) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416116) |
| 1223X2210X Dentist, Orofacial Pain (Licence: NY 061463) | |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2022-01-02 |