| NPI | 1073910113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 11300) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 11300) |
| 122300000X Dentist (Licence: NY 057448) | |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2015-04-02 |