| NPI | 1649658691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 058555) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058555) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2019-07-09 |