| NPI | 1053964809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02767700) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060838-01) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2019-11-06 |