| NPI | 1285062539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 049949-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02184800) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2020-07-22 |