| NPI | 1275730186 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02553200) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019646) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2017-04-11 |