| NPI | 1679575153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 051074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037024) |
| Enumeration Date | 2005-08-13 |
| Last Update Date | 2024-03-14 |