| NPI | 1598967721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14265) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050231) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2015-07-17 |