| NPI | 1396942397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI02615800) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019662) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 564331) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2018-03-17 |