| NPI | 1982827556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11777) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 051725) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2024-08-07 |