| NPI | 1962951772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 13422) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50-058814) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2022-10-26 |