| NPI | 1295870111 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CT 9222) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 049666-1) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2012-03-06 |