| NPI | 1073739066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS036624) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02309000) |
| 122300000X Dentist (Licence: NY 053416) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2012-06-04 |