| NPI | 1598966228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 12335) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MD 12335) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-01-09 |