| NPI | 1376952168 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058993-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009058) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2017-03-28 |