| NPI | 1538289095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 053442-1) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 21688) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |