| NPI | 1336717941 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 062606) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 14529) |
| 1223G0001X Dentist, General Practice (Licence: OH RES.004382) | |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2026-04-16 |