| NPI | 1922580406 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059848) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 059848) |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2018-08-31 |