| NPI | 1184820490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02330600) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052417) |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2012-04-02 |