| NPI | 1114162930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 10904) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056607-1) |
| 122300000X Dentist (Licence: CT 009954) | |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2020-12-01 |