| NPI | 1568767440 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 057699) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10363) |
| 1223P0700X Dentist, Prosthodontics (Licence: CT 11311) | |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2014-12-04 |