| NPI | 1780138222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 06012) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.24864) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901022056) | |
| 1223G0001X Dentist, General Practice (Licence: NY 06012) | |
| Enumeration Date | 2016-08-13 |
| Last Update Date | 2019-10-10 |