| NPI | 1740521897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 100867) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057978-1) |
| 1223G0001X Dentist, General Practice (Licence: NY 057678-1) | |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2019-08-08 |