| NPI | 1619967585 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 11285) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 050393-1) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-11-01 |