| NPI | 1518087071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02503700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052955) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2012-07-17 |