| NPI | 1093198301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN21816) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058481) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2019-01-22 |