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 |