| NPI | 1477819365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MD 15118) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055685-1) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2015-07-20 |