| NPI | 1588194914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ pending) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02687600) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2018-03-17 |