| NPI | 1740482991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0411000032) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 037539-1) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2007-07-08 |