| NPI | 1124376397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 056261) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056261) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2016-05-25 |