| NPI | 1629210182 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 042090) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MD 13829) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2009-03-30 |