| NPI | 1346434198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: NY 051291) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21833) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2013-09-10 |