| NPI | 1063821346 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NY 057173) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 057173) |
| 1223G0001X Dentist General Practice (Licence: PA DS039462) | |
| 1223P0700X Dentist Prosthodontics (Licence: PA DS039462) | |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |