| NPI | 1609098177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 054802) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019443) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2010-12-08 |