| NPI | 1255652699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 055097) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS038176) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2010-10-20 |