| NPI | 1457703589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 22140) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059277-1) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-03-16 |