| NPI | 1760785547 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 50054334) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 50054334) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2021-11-03 |