| NPI | 1376854042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 055585) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02470500) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2014-07-02 |