| NPI | 1962889618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 060299-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16163) |
| 122300000X Dentist (Licence: DC DEN1001562) | |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2019-11-19 |