| NPI | 1770871303 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 50 055503) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 50 055503) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2020-06-26 |