| NPI | 1114310679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059681-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02705800) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2021-10-04 |