| NPI | 1518456672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02740700) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2019-01-31 |