| NPI | 1548487663 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 1857827) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 050309) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-03-22 |