| NPI | 1487899886 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 054831-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02389900) |
| Enumeration Date | 2008-12-14 |
| Last Update Date | 2016-05-19 |