| NPI | 1013910025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN29796) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 047352) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2025-05-22 |