| NPI | 1467665612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 010353) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 052960) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2012-11-13 |