| NPI | 1356663892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 055408) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038140) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2011-05-05 |