| NPI | 1801302021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 06127001) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 102118) |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2021-04-14 |