| NPI | 1861799793 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SD D1022) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055282-1) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2014-04-24 |