| NPI | 1548389281 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 051038) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS035412) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2014-11-18 |