| NPI | 1588010672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059257) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02670500) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2018-03-31 |