| NPI | 1982174744 |
|---|---|
| Former Name | MARIA GABRIELA TIBAVINSKY BERNAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 060774) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN015657) |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2023-01-25 |