| NPI | 1083905038 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056531) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: NJ 22DI02509800) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2013-02-21 |