| NPI | 1639167828 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD2678) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050839) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2014-03-11 |