| NPI | 1770775991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 053594) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 0535941) |
| Enumeration Date | 2007-08-12 |
| Last Update Date | 2014-04-14 |