| NPI | 1750531554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 054419) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY P64182) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2020-12-01 |