| NPI | 1508502071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 064744) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 064744) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2026-04-01 |