| NPI | 1982685194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD3474) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL HAD83) |
| 1223G0001X Dentist, General Practice (Licence: NY 043984-1) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2021-09-21 |