| NPI | 1275150559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042790) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 062227-01) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2023-01-31 |