| NPI | 1255773487 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059672-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414118) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2019-01-26 |