| NPI | 1760400659 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8825) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 048104) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-02-25 |