| NPI | 1487126959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 061135) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858737) |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2022-09-18 |