| NPI | 1790949931 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NY 053897) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053897) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2014-06-10 |