| NPI | 1972865152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 046141) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 046141) |
| 1223E0200X Dentist Endodontics (Licence: NY 046141) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: NY 046141) | |
| 1223P0300X Dentist Periodontics (Licence: NY 046141) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-06-13 |