| NPI | 1629141452 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412114) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052401) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2015-08-10 |