| NPI | 1952564429 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 054629) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY P63939) |
| 1223G0001X Dentist, General Practice (Licence: NY P63939) | |
| 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02544500) | |
| Enumeration Date | 2008-07-05 |
| Last Update Date | 2013-10-17 |