| NPI | 1790983534 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 054103) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 009791) |
| 1223G0001X Dentist, General Practice (Licence: NY 054103) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2025-05-20 |