| NPI | 1992924450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 050640) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 6087) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2009-11-04 |