| NPI | 1891018636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 055793) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013992) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2013-11-18 |