| NPI | 1851063572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 063371) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 12981) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2023-09-22 |