| NPI | 1841563012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 037977) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN15717) |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2012-02-17 |