| NPI | 1649648593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 061496) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 65007) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2021-02-01 |