| NPI | 1750767570 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058803) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2018-03-17 |