| NPI | 1417164203 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 054339-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037218) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2012-06-08 |