| NPI | 1801272893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 060914) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QA1903X Clinic/Center, Ambulatory Surgical | |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2020-04-07 |