| NPI | 1588827596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC 054754) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY P65010) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2019-05-14 |