| NPI | 1851179634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 000150-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418651) |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2024-05-13 |