| NPI | 1053560508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9251) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053190) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2012-06-20 |