| NPI | 1003057589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02392800) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50 054522) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2013-10-30 |