| NPI | 1003964339 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 051337) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30466) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2018-08-13 |