| NPI | 1053822486 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 060930-01) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02692700) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2021-06-03 |