| NPI | 1669564019 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9958) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 044610) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2021-12-17 |