| NPI | 1710288295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 054768) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 59770) |
| Enumeration Date | 2010-11-15 |
| Last Update Date | 2015-08-10 |