| NPI | 1205175403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 30395) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02570100) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2015-06-08 |