| NPI | 1902060478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 054260) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054260) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-04-08 |