| NPI | 1699735381 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 052426) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052426) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2010-10-01 |