| NPI | 1912046293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14578) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 050452-1) |
| 1223P0300X Dentist, Periodontics (Licence: CA 55596) | |
| 122300000X Dentist (Licence: VA 0401414570) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2017-02-28 |