| NPI | 1366531469 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059572) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 52169) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-08-21 |