| NPI | 1689171696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL dn23753) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060577) |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2024-07-11 |