| NPI | 1053452359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 009859) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 0520021) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2011-08-09 |