| NPI | 1447538319 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 055535-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055535-1) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2015-04-14 |