| NPI | 1437480506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 05854) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58757) |
| 122300000X Dentist (Licence: MI 2901019914) | |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2015-12-23 |