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 |