| NPI | 1548031032 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 000148) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418686) |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-01-12 |