| NPI | 1891312419 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 064187-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 36343) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2024-08-29 |