| NPI | 1285610329 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 054654) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035827) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2011-02-28 |