| NPI | 1649609496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS031415L) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 049062) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2013-11-02 |