| NPI | 1821346834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 056062) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 010753) |
| Enumeration Date | 2012-08-22 |
| Last Update Date | 2012-08-22 |