| NPI | 1679814719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 057785) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 057785) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2022-09-16 |