| NPI | 1659740231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 058151) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10223) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2016-09-12 |