| NPI | 1417970575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 009630) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 54329) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2011-05-20 |