| NPI | 1265711246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02597100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055682) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2022-07-21 |