| NPI | 1386938520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058180-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 19351) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2015-10-08 |