| NPI | 1306055819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 12683) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 053295) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2025-07-28 |