| NPI | 1174651210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN17802) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052839-1) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-07-08 |