| NPI | 1801941901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 050324) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 050324) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2022-03-18 |