| NPI | 1013032903 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 09753) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MD 9753) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-03-04 |