| NPI | 1003255084 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 10962) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02544400) |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2018-03-17 |