| NPI | 1619092194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY 042182) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 042182) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2018-10-09 |