| NPI | 1073762506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN16843) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 053567) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2018-01-10 |