| NPI | 1578910071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 001199) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058441) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2017-05-10 |