| NPI | 1104478189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02762900) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ DI02762900) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2019-08-05 |