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 |