| NPI | 1740545706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NY 0584111) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855969) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2019-04-27 |