| NPI | 1912168311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414235) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 043900) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2020-08-10 |