| NPI | 1245779479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01537400) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401006046) |
| 122300000X Dentist (Licence: WI 2742-15) | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2017-02-21 |