| NPI | 1194111054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 058885) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI263600) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2018-09-06 |