| NPI | 1417368283 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 046055) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 046055) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2019-01-17 |