| NPI | 1053714014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 057639-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02582700) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2014-10-06 |