| NPI | 1609323948 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN22702) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22702) |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 058818) | |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2018-01-11 |