| NPI | 1366590440 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NJ 22DI02239900) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 050210) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2013-09-06 |