| NPI | 1396134235 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401415403) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057606) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2018-03-17 |