| NPI | 1366588717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 058399) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21789) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2018-02-07 |