| NPI | 1790983112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA DSO36038p) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 051058) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2009-10-20 |