| NPI | 1447487798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 61226) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 000085-1) |
| 1223G0001X Dentist, General Practice (Licence: NY 055241) | |
| Enumeration Date | 2009-06-14 |
| Last Update Date | 2021-09-22 |