| NPI | 1720285968 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 23064) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50053110) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2012-12-05 |