| NPI | 1396039293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 056640) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS038532) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2014-01-22 |