| NPI | 1558450767 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 063602) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 21458) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-11-14 |