| NPI | 1205464864 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 062387) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN4907) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2023-08-25 |