| NPI | 1164068029 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 13261) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 061722) |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2022-10-21 |