| NPI | 1861825937 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856754) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056668) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2019-10-08 |