| NPI | 1548491095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 052194-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D102364000) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2023-05-23 |