| NPI | 1558767400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN22191) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02574400) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ 22DI02574400) | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2018-04-14 |