| NPI | 1376663708 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 046401) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 214982-1) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2009-11-16 |