| NPI | 1063694719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013472) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50 050784) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2007-12-04 |