| NPI | 1649931205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NY 000122) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: VA 0401417635) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-01-05 |