| NPI | 1467807123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 059182) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 059182) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2018-03-17 |