| NPI | 1083967939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056805) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D102507000) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2014-01-29 |