| NPI | 1992916589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 051297) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 009314) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |