| NPI | 1548791049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 062386-01) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041597) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2022-11-07 |