| NPI | 1477819803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 12524) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057621) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 057621) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2022-11-30 |