| NPI | 1528289519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY NY042677-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 0426771) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2009-04-23 |