| NPI | 1972843670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NY 042723) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 042723) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2013-10-30 |