| NPI | 1619056280 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: FL DN 20025) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY SOLOL1) |
| 174400000X Specialist (Licence: MA 21786) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2018-08-06 |