| NPI | 1700963535 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 042349) |
| Additional Taxonomies | 125Q00000X Oral Medicinist (Licence: NY 042349) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-03-01 |