| NPI | 1104930056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 057009) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02329900) |
| 122300000X Dentist (Licence: NY 9363084) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2016-10-05 |